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Neuroimaging: Widely Overused in Migraine/Headache Patients

Because post-traumatic headache claims and neuroimaging appear so often in traumatic brain injury litigation, the high cost of neuroimaging is particularly of interest to us. Patients spend nearly $1 billion per year on neuroimaging in connection with headaches or migraines. However, only 1-3% of patients with chronic headaches have identifiable abnormalities appearing on neuroimaging. A 2014 article in the Journal of the American Medical Association found that neuroimaging is likely “substantially overused” in cases with individuals who have headaches and migraines. This may be because anxious patients are requesting unnecessary neuroimaging to assess brain function, and because doctors are not doing their part to educate patients on the costs of neuroimaging.

Guidelines issued in 2000 by the American College of Radiology, as part of the Choose Wisely campaign, attempted to stem the overuse of neuroimaging. Those guidelines recommended against the routine use of CT and MRI scans for uncomplicated headaches, because serious intracranial injuries are very rarely the cause of headaches. In 2000, when these guidelines were issued, only about 8% of individuals with headache underwent neuroimaging. However, from 2007 and 2010, about 22.2% obtained neuroimaging. One thing’s for certain: the guidelines aren’t helping with the overuse of neuroimaging in headache cases.

The Choosing Wisely Campaign aims to educate patients on the overuse of neuroimaging techniques. Patient education is a primary factor for alleviating patient anxiety and bringing down the overall cost of neuroimaging. Hopefully, campaigns like Choosing Wisely can help decrease high healthcare costs.